COLOR DOPPLER ULTRASOUND-DIRECTED PERCUTANEOUS ALCOHOL INJECTION IN THE TREATMENT OF FUNCTIONAL AUTONOMOUS THYROID-NODULES

In a prospective study, 26 patients (18 women, 8 men; mean age 74 [51-92] years) with clinically and biochemically confirmed hyperthyroidism and autonomous thyroid nodules, as proven by scintigraphy and colour Doppler ultrasound (CDUS), the nodular tissue was destroyed by alcohol injection. All patients had multinodular goitre, eleven with solitary adenoma and 15 with two or more adenomas. Under continuous CDUS monitoring 2-4 ml of 96% ethanol per injection were instilled in a total of 87 sessions (mean of 3.3 injections per patient). Minor side effects (pressure sensation, pain, reddening) occurred with five injections. The effect of the treatment was a reduction in size and cystic degeneration of the nodule, as well as decreased vascularization as demonstrated by CDUS. A euthyroid state was achieved, without any additional thyrostatic drugs, within 5 weeks in 18 of the 26 patients, while in eight the initial carbimazole dosage could be reduced to a quarter. After 6 weeks 11 nodules had become scintigraphically inactive. In 12 patients the technetium uptake had been reduced and initially suppressed paranodular tissue again showed functional activity. - These observations indicate that the described method is an efficacious and cost-effective out-patient procedure with few side effects far the treatment of hyperthyroidism associated with single or several autonomous thyroid nodules. The localization of the hyperactive adenomas should be done together with scintigraphy and CDUS.